Minimally Invasive Surgical Treatment Versus Medical Management for Stroke Patients With Atrial Fibrillation

Not Applicable

Completed

Brief Summary: The purpose of this study is to compare a minimally invasive surgical procedure and medication management in stroke patients with Atrial Fibrillation. The two treatment options are a minimally invasive surgical procedure or the use of medications.

Detailed Description: Must have had a stroke or transient ischemic attack (TIA) and have Atrial Fibrillation

Recruitment & Eligibility

Inclusion Criteria

Patients with a history of stroke and paroxysmal, persistent or permanent AF.
Ischemic stroke or TIA with documented paroxysmal or persistent atrial fibrillation. A TIA will meet inclusion criteria as a sudden-onset focal neurological symptom or sign lasting at least 10 minutes but less than 24 hours with or without evidence of acute brain ischemia on diffusion weighted MRI imaging.
Eligible symptoms INCLUDE hemiplegia or hemiparesis, monoplegia, or language disturbance other than isolated dysarthria.
Symptoms that will NOT QUALIFY AS TIA INCLUDE transient monocular blindness in both eyes, dysarthria, vertigo,isolated sensory symptoms, confusion, memory loss, nonspecific complaints of dizziness, or syncope.

Exclusion Criteria

Recent stroke (< 1 month).
Age < 18 or > 80 years; Ejection Fraction < 25%• Presence of left atrial appendage thrombus on CT or echocardiography
Previous empyema or thoracic surgery, preventing access to the pulmonary veins via thoracoscopy.
Left Atrial Diameter > 55mm.
Contraindication to anticoagulation with Coumadin.
Mitral insufficiency (> 2+)
• • Contraindications to MRI
•Artificial heart valve prosthesis
Aneurysm clips
Implanted drug infusion device or pump
Any type of neurotranstimulator
Any type of bone growth stimulator
Cochlear implants or inner ear prosthesis
Any intravascular coils, filters, or stents
Shrapnel or bullets
Other metallic implants or devices specify which
Permanently tattooed eyeliner
Are you pregnant or suspect to be pregnant?

Arm && Interventions

Group	Intervention	Description
Medical Therapy	Medical therapy	Patients are treated with rhythm and rate control medications.
Minimally Invasive Surgery	Minimally Invasive Surgery	Thumb sized incisions are made on each sides of the chest wall where instruments are placed in the chest to perform the surgery.

Primary Outcome Measures

Name	Time	Method
Quality of Life RAND 36-Item Health Survey	Change in baseline, 3 month, and 6 month	Compare quality of life of patient satisfaction between the surgery and or the medication in stroke patients with AF (atrial fibrillation). The RAND 36-Item Health Survey taps eight health concepts: physical functioning, bodily pain, role limitations due to physical health problems, role limitations due to personal or emotional problems, emotional well-being, social functioning, energy/fatigue, and general health perceptions. It also includes a single item that provides an indication of perceived change in health. Note that all items are scored so that a high score defines a more favorable health state. In addition, each item is scored on a 0 to 100 range so that the lowest and highest possible scores are 0 and 100, respectively. Scores represent the percentage of total possible score achieved. Items in the same scale are averaged together to create the 8 scale scores which will have a 0 to 100 range.

Secondary Outcome Measures